Dynamics of the Liver Stiffness Value Using Transient Elastography during the Perioperative Period in Patients with Valvular Heart Disease

Abstract

Background/AimsLiver congestion due to heart failure in patients with valvular heart disease (VHD) can result in an overestimate of the liver stiffness (LS) as assessed by transient elastography (TE). This prospective pilot study investigated the dynamics of LS during the perioperative valve operation period.MethodsThirty-two patients who underwent a valve operation (case) and 12 who underwent a varicose vein operation (control) were prospectively enrolled. LS and cardiologic parameters at three time points [baseline, post-operative day (POD)7, and POD90] were collected.ResultsLS at three time points were consistently higher in the case group than those in the control group, although all participants did not show evidence of underlying chronic liver disease (all P<0.05). In the case group, LS at POD7 increased slightly from the LS at baseline (median 7.9→8.4 kPa, P = 0.816), whereas LS at POD90 decreased significantly from the LS at POD7 (median 8.4→6.0 kPa; P = 0.026). LS was significantly correlated with N-terminal-pro brain natriuretic peptide (NT-proBNP) (ρ = 0.412), left ventricular ejection fraction (ρ = −0.494), and central venous pressure during the operation (ρ = 0.555) at baseline (all P<0.05). LS was significantly correlated with NT-proBNP (ρ = 0.526) and right ventricular pressure (ρ = 0.572) at POD7, whereas LS was significantly correlated with NT-proBNP (ρ = 0.590) at POD90 (all P<0.05).ConclusionsLS can be overestimated in patients with VHD due to hepatic congestion. However, LS can be dynamically reversed during the perioperative period reflecting the restoration of cardiac function after a successful operation.

Liver stiffness measurements for evaluation of central venous pressure in congenital heart diseases

“…Baseline median LS was lower and within normal ranges in our population (5 kPa) compared with these articles 9 10. This is likely due to the difference of age distribution between the two populations—our patients tend to be younger with preserved cardiac function—even if the relationship between LS and age remains controversial 16 19.…”

“…Other than Millonig et al ,8 Chon et al 9 investigated the dynamics of LS during the perioperative period after valvular heart surgery in 32 adult patients. They showed that LS could be dynamically reversed during the perioperative period.…”

Prognostic Relevance of Liver Stiffness Assessed by Transient Elastography in Patients With Acute Decompensated Heart Failure

“…7 Several groups have examined the effect of HF on the liver. [16][17][18] In a clinical study, LS measured by TE increased in patients with HF, and inter- Values are expressed as median (interquartile range), or n (%). A, late transmitral flow velocity; a', septal mitral annular late diastolic velocity; E, early transmitral flow velocity; e', septal mitral annular early diastolic velocity; E/e', ratio of peak mitral E wave velocity to peak early diastolic myocardial velocity at septal position recorded by tissue Doppler imaging; IVC, inferior vena cava; LAd, left atrial diameter; LVDd, left ventricular end-diastolic diameter; LVDs, left ventricular end-systolic diameter; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; RAP, right atrial pressure; RVDd, right ventricular end-diastolic diameter; TAPSE, tricuspid annular plane systolic excursion; TR, tricuspid regurgitation; TRPG, tricuspid regurgitation pressure gradient.…”

Assessment of Advanced Liver Fibrosis and the Risk for Hepatic Decompensation in Patients With Congestive Hepatopathy

“…This concept is well demonstrated in a prospective study of 32 patients with valvular heart disease who underwent TE before and after valvular repair. Ninety days postoperatively, patients demonstrated a significant decline in liver stiffness (from 8.4 to 6.0 kPa, P = 0.026), suggesting improvement in congestion rather than reversal of fibrosis given the short time frame …”

“…Ninety days postoperatively, patients demonstrated a significant decline in liver stiffness (from 8.4 to 6.0 kPa, P = 0.026), suggesting improvement in congestion rather than reversal of fibrosis given the short time frame. (30) Only one small study (n = 10) exists comparing liver stiffness determined by TE to fibrosis stage by biopsy, and no studies exist for ARFI. In the TE study, liver stiffness values overestimated the amount of fibrosis by at least one stage in 7 out of 10 subjects and overestimated the level of fibrosis by at least two stages in 5 out of 10 subjects.…”